What repealing the Medicaid expansion provisions in the Affordable Care Act would mean to Illinois

President Trump has promised to repeal the Affordable Care Act (ACA), often known as “Obamacare.”   However, he and the Republican leaders in Congress have not yet made clear whether some provisions of the ACA will survive and, what, if anything, would replace the ACA.  The ACA provision which has been most helpful to persons with mental illnesses in Illinois is the one which allowed Illinois to substantially expand its Medicaid program.

Under the ACA, states are allowed to chose whether to expand coverage of their Medicaid program.  Historically Medicaid has been available only to persons whose income is at or below 100% of the Federal poverty level.  The Medicaid expansion provisions of the ACA allow persons making up to 138% of the poverty level to be covered.  Importantly, the Federal government covers between 90 and 100% of the cost of care for persons in the Medicaid expansion program.  For persons in the “traditional” Medicaid population the Federal share is typically only 50%.  Thus, Illinois and the 30 other states which have thus far elected to expand Medicaid are able to provide health care to more than 11 million new people at little or no cost to state taxpayers.  In Illinois, more than 650,000 people are now covered by Medicaid due to the expansion provisions of the ACA.  In the 18-month period between January 2014 and June 2015, the Federal government paid $3.3 billion for health care for persons in the Medicaid expansion population in Illinois.  Illinois paid only $52 million as its share–less than 2%.  This data is from “What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?” The Kaiser Commission on Medicaid and the Uninsured (December, 2016)

Illinois is already in very bad fiscal shape. If President-elect Trump and the United State Congress eliminate the Medicaid expansion program, it is extremely unlikely that Illinois would be able to find additional billions of dollars to cover health care costs for more than 650,000 Medicaid expansion enrollees.  Many of these people have serious mental illnesses.  They will no longer be able to get treatment for their mental illness or any other health care condition.  This will harm them and their families and communities.

  1. Action items:  Tell your United States Senator and Congressperson  not to repeal the Medicaid expansion provisions in the ACA.
  2. Show up at a town hall meeting and tell your Senator and Congressperson not to repeal the Affordable Care Act.

Letter to Governor Rauner concerning the possible repeal of the ACA: protect-medicaid-aca-governor-rauner-letter_final_12-15-2016

Click here for a link to a Petition to Save the Affordable Care Act.

Urban Institute; The Implications of Partial Repeal of the ACA.

Latest House Republican plan for ACA repeal 

Click here for a link to the Protect our Care Illinois website.

Still no budget–Things about to get worse

In June, 2016, the Illinois legislature finally passed and the Governor signed a “budget” for Fiscal Year 2016 which was just ending on June 30th and for the first six months of Fiscal Year 2017.  This “budget” ends on December 31,2016.

The budget which is ending on December 31st is not real.  That is because it is just a spending plan with no new revenue.  Every day for the past 18 months, Illinois has gone deeper into debt.  indeed, for many, many years we have put off raising taxes and borrowed from our future.  The current “budget” just accelerated our borrowing.  Every day that we postpone raising taxes and cutting spending makes the task of enacting a balanced budget more difficult because our existing debt gets bigger.

Everyone knows that spending cuts alone will not solve this problem.  No public official from either party has proposed a balanced budget which does not include a tax increase.

Action item:  Advocates for a decent mental health system in Illinois must continue to tell their state senator and state representative and the Governor to agree on a balanced budget and agree to raise taxes.  


“Stop gap” budget passed; much more work must be done

On June 30th, the Legislature passed and Governor Rauner signed a so-called “stop gap” budget: Public Act 99-0524.  This budget covers an 18-month period from July 1, 2015 through December 31, 2016.  This is the first actual budget enacted to cover Fiscal Year 2016 which ended on the day the budget was enacted.  The good news is that this budget should enable some mental health and other human services providers to receive payment for services that they have already provided.   However, this does not include some mental health services which were in the Fiscal Year 2015 budget and which providers continued to offer to persons with mental illnesses in the hope that they would eventually be reimbursed.  This further harms many behavioral health care providers whose financial condition is precarious. Click here for a link to some of the cuts to human services providers across Illinois.

Worse still is the fact that Public Act 99-0524 does not contain any new revenue.  This means that every day Illinois’ multi-billion dollar deficit is growing worse.  The budget continues the practice we have had for the past year of spending more money than we are taking in.  This reality has many causes.  However, one of the most important was allowing the state income tax rate to be cut by one third on January 1, 2015.  Because our deficit is getting worse every day, every day it becomes harder for us to solve this problem.  That is because eventually we will need to balance the budget and pay back all of the money we have borrowed.  That means that the amount of new revenue and/or cuts to vital services that will be be needed increases every day.  It is very important that mental health advocates continue to communicate to Governor Rauner, to our state senators and to our state representatives that we need more revenue and we need it as soon as possible.  

We still have no state budget: what must be done.

The 2016 regular session of the Illinois legislature ended on May 31st, 2016 with no state budget.  We have now gone eleven months without a budget.   Every day the state gets further in debt and further behind in paying human services providers.   In human terms that has caused staff layoffs and serious cut backs in community mental health services. Providers that are able to do so, have been borrowing money.  But borrowing money is not free and borrowed money must be paid  back.  In state psychiatric hospitals, there are staff shortages and shortages of every day necessities such as toilet paper, toothpaste and towels.

Enough is enough!!!

Everyone who cares about providing decent and human care and services to persons with mental illnesses should:

  1. Call Governor Rauner and urge him to sign Senate Bill 2038 which restores funding for human services.
  2. Call your State Senator and State Representative and urge them to pass a revenue bill to support funding for human services.  Yes this means a tax increase.  The state is $7 billion in debt and we cannot afford decent mental health services without a tax increase.  Click here to find the contact information for your legislators.

Mental Health Rally Today–May 19th

Persons with mental illnesses, mental health advocates and mental health service providers will come together on May 19, 2016 to protest the extremely painful cuts to mental health and other human services.  Here are the details:

Date:  May 19, 2016

Time:  10 am to 11 am

Location:  Thompson Center Plaza, Northwest Corner of Randolph and Clark Streets, Chicago.  

Every day the harm gets worse.  Now there are shortages of necessities in our state mental hospitals, including toothpaste, mouthwash, soap and toilet paper.  Please bring a roll of toilet paper to the rally.

For more information contact:  Mark Heyrman:  m-heyrman@uchicago.edu

This Rally is sponsored by the Mental Health Summit, Mental Health America of Illinois and NAMI-CHICAGO.

Budget stalemate continues–persons with mental illnesses suffer

On February 16th, 2016, Governor Bruce Rauner presented his proposed budget for Fiscal Year 2017 as required by the Illinois Constitution.  This budget was presented despite the fact that, eight months into Fiscal Year 2016, Illinois does not yet have a budget for the current year.  The Governor’s budget address made it clear that he was not changing his position about what was needed for a settlement.  The responses from the leaders of the Illinois House (Speaker Michael Madigan) and Senate (Senate President John Cullerton) made it clear that they are also not changing their positions.  So the impasse continues with no end in sight.

The details of the Governor’s proposed budget make it clear that funding for mental health services will continue to suffer.   Here are links to the proposed budgets for the Department of Human Services and the Department of Healthcare and Family Services. Important programs for people with mental illnesses are also facing reductions in the budgets for the Department of Aging, the Department of Children and Family Services and the Department of Public Health.

In the meantime, the budget impasse is causing substantial cutbacks in mental health and other human services.  For example, Lutheran Social Services of Illinois, one of the largest social service agencies in the state has been forced to layoff one third of its staff.  These layoffs are the direct result of the failure of the state to pay the numerous human services providers across the state.  Some providers have been able to borrow money to maintain services.  However, that ability declines every day.

Because outside contractors are not being paid and because of other cutbacks, persons confined in state psychiatric hospitals are complaining of shortages of food, clothing and toiletries.  They are also concerned because these facilities are saving money by turning down the heat.  Illinois is becoming a third-world country in its treatment of people with disabilities.

it is past time to resolve this impasse.  Tell the Governor and the legislative leaders that we need a budget NOW which contains adequate funding for persons with mental illnesses.  Among other things, please communicate your support for the Responsible Budget Resolution.

Attached is correspondence concerning shortages at McFarland Mental Health Center, the state-operated psychiatric hospital in Springfieldmcfalrand-full package

Here is a link to more information about the effects of the budget crisis on services in Illinois.

Here is a link to the statement of the Illinois Association of Rehabilitation Facilities before the Senate Appropriations Hearing on March 16, 2016: 2016-03-15 – IARF Statement – Senate Appropriations I – DHS Proposed Budget

Here is a link to the statement of the Community Behavioral Healthcare Association to the Appropriations Committee on March 16, 2016: FY17 Senate Approp I Testimony 031616–cbha

CMS Responds to Our Concerns-Rescinds Proposal to Limit Access to Psychotropic Medications

Responding to a huge outpouring of concerns and complaints from the mental health advocacy community across the country and also to pressure from Congress, the Center for Medicare and Medicaid Services (CMS) reversed its decision to limit access to psychotropic medications.  Virtually every mental health organization in Illinois and across the country communicated to CMS  and to Congress our opposition to this proposal which would have allowed Medicare Part D providers to restrict access to medications for the treatment of serious mental illnesses.  Bravo to everyone who joined in the effort to stop this bad policy from taking effect.

In the meantime, Congress is considering legislation to prohibit CMS from going forward with such a rule.  

Below are links to information about the  CMS change of heart:

Partnership applauds CMS

Obama drops Medicare Proposal

National Council press release

NAMI press release

New York Times article–March 11, 2014